Finding 479513 (2023-003)

Sliding Scale Assessment Material Weakness U.S. Department of Health and Human Services ALN #: 93.224 Federal Award Identification #: H80CS00594 Condition: The sliding scale assessment and approval based on the patient’s ability to pay was not always accurately performed or applied. Criteria: 42 CFR Part 51c.303 (f) Questioned Costs: $0 Context: For 5 out of 25 patients tested, Christian Community Health Center incorrectly calculated and applied the sliding scale fee discount based on the published HHS poverty guidelines. Additionally, 2 of those patients did not have documented approval of the sliding fee discount. For another patient, the assessment was correctly made but they did not charge the patient the correct sliding scale fee. Cause: Management oversight, challenges in the system with pulling from the correct poverty guidelines. It appears that vendor for the electronic record system has not updated the poverty tables appropriately. Effect: Non-compliance with federal regulations. Identification as repeat finding, if applicable: 2022-005 Recommendation: We recommend that management review the system to ensure it is pulling the correct poverty guidelines. We also recommend a periodic secondary review be completed to ensure accuracy of sliding scale assessment and that supervisory approval is documented. Views of Responsible Officials and Planned Corrective Action: Management agrees with the finding. See corrective action plan.